Healthcare Fraud Shield’s Latest Article: What you should know about LEQEMBI
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
LEQEMBI is a newly approved drug by the U.S. Food and Drug Administration (FDA) for the treatment of Alzheimer’s disease. According to the FDA, “Alzheimer’s disease is an irreversible, progressive brain disorder affecting more than 6.5 million Americans that slowly destroys memory and thinking skills, and, eventually, the ability to carry out simple tasks”.[1]LEQEMBI is approved for the treatment of Alzheimer’s Disease in patients diagnosed with either mild cognitive impairment or mild dementia stage of disease. The appropriate diagnoses would be one of the following[2 ..read more
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Healthcare Fraud Shield’s Latest Article: Happy Hour at the Drip Bar?
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
Yes, there is a new bar in town and not the kind you think. They are known as IV Drip bars. You can get IV fluids at these trendy concierge IV Drip bars, in the comfort of your own home, at drip parties or almost any location nowadays with the mobile services. Many folks are getting an IV of various vitamins, minerals, and electrolytes. What are the benefits? As a reminder, you should always consult with your doctor regarding the safety and efficacy of any treatment. IV Drip bars boast about benefits such as hydration, immune support, fatigue, hangovers, anti-aging, pain relief and m ..read more
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Healthcare Fraud Shield’s Latest Article: Upcoding HCCs–Diabetes
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
What is an HCC? An HCC is a Hierarchical Condition Category which is used to calculate risk scores that may predict the future cost of healthcare for enrollees. HCCs were implemented by the Centers for Medicare and Medicaid (CMS) and have been adopted by Medicare Advantage Plans.   Medicare Advantage Plans engage in prospective reviews to ensure accurate coding and payments. HCCs are used to ensure payers are properly compensated for the overall cost of care for each member.[1] Accurate HCCs involve using the CMS-HCC model to determine the appropriate diagnosis codes.  ..read more
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Healthcare Fraud Shield’s Latest Article: Oh, Oh….Ozempic
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
Ever have a commercial jingle stuck in your ahead? If you haven’t heard the Ozempic jingle feel free to listen here. Manufactured by Novo Nordisk, Ozempic is prescribed to patients to treat Type 2 diabetes and to reduce the risk of adverse cardiovascular events. Novo Nordisk recommends patients also engage in diet and exercise while taking Ozempic.[i] While Ozempic is not approved as a weight loss drug, weight loss was noted as a common side effect. [ii] Ozempic and other drugs used to treat diabetes have garnered the attention of many celebrities.[iii]  What’s the Concern With ..read more
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Healthcare Fraud Shield’s Latest Article: Coding Crisis Psychotherapy
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
What is Crisis Psychotherapy? Crisis Psychotherapy is a session that occurs between the provider and the patient due to a life-threatening or highly complex issue that requires immediate attention.[1] According to the coding guidelines, “Psychotherapy for crisis is an urgent assessment and history of a crisis state, a mental status exam, and a disposition. The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma. The presenting probl ..read more
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Healthcare Fraud Shield’s Latest Article: Hospital Observation Codes in 2023 – Gone!
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
Prior to the 2023 Current Procedural Terminology (CPT) code set, there were several codes specifically used for hospital observation services[1]: CPT 99217 (Observation discharge) 99218-99220 (initial observation care) 99224-99226 (subsequent observation care) All of the above-mentioned codes were removed and the services are now included in other existing codes. What codes can you use for observation in 2023? Observation care will now be included in the following existing initial, subsequent, discharge day codes[2]: Report observation discharge services with CPT 99238, 99239 Report initial ..read more
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Healthcare Fraud Shield’s Latest Article: 2023 Hernia Repair Code Changes
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
What is Hernia? Hernia is when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. There are several types of hernia including inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach). [1] How is it Billed? There are different Current Procedural Terminology Codes (CPT) based on the type of hernia and the surgical approach. However, 2023 brought many change to this section of codes to address reporting of “hybrid” abdominal hernia repair procedures wh ..read more
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Healthcare Fraud Shield’s Latest Article: Keeping An Eye On Vabysmo
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
What is Vabysmo? According to the manufacturer (Genentech), VABYSMO (faricimab-svoa) is a prescription medicine given by injection into the eye, used to treat adults with Neovascular (Wet) Age-related Macular Degeneration (AMD or nAMD) and Diabetic Macular Edema (DME).[1] AMD and DME are two of the leading causes of vision loss. Genentech announced in January of 2022 that this drug was approved by the FDA.[2] How is it billed? CMS (Centers for Medicare & Medicaid Services) announced a new Healthcare Common Procedure Coding System (HCPCS)  J-code to represent Vabysmo – J2777 ..read more
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Healthcare Fraud Shield’s Latest Article: Suvorexant and Opioid Withdrawal
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
The Opioid epidemic continues to plague many individuals resulting in overdoses and in some cases death. According to the CDC, in 2020 almost 75% of drug overdoses were attributed to or involved an opioid. Opioid death rates  (which included individuals prescribed and not prescribed medications) increased from 2019 to 2020.[1] Those actively battling withdrawal often experience a host of side effects. Opioid Withdrawal Individuals experiencing withdrawal symptoms may suffer from muscle aches, restlessness, anxiety, lacrimation, runny nose, excessive sweating, inability to sleep ..read more
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Healthcare Fraud Shield’s Latest Article: Understanding Modifier Q6
Healthcare Fraud Shield
by Healthcare Fraud Shield
1y ago
A locum tenens provider is someone who does not own their practice but serves as a travelling provider filling in for other providers who are unable to work due to a variety of reasons, including illness. Locum tenens is now referred to as Fee-For-Service Time Compensation physicians who serve as substitute. [1] These providers are typically paid on a per diem basis, work in short term agreements, and are considered a contractor versus a full-time salaried employee.  How is it billed? Claims may be submitted for services rendered by a physician or physician therapist for covered ..read more
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